"This report is the first instalment of the ‘Social Science in Epidemics’ series, commissioned by the USAID Office of U.S. Foreign Direct Assistance (OFDA). In this series, past outbreaks are reviewed in order to identify social science ‘entry points’ for emergency interventions and preparedness activities. The aim is to determine tangible ways to address the social, political and economic dynamics of epidemics and to ensure that interventions build on the social and cultural resources of the communities they aim to support. This report explores lessons about the social dimensions of past and recent Cholera epidemics.

How to read this report:

this document provides an in-depth review of evidence on different aspects of Cholera epidemics. It is organised into the following categories, and readers with a specialist interest can skip to the relevant category:Emergence Page 2Surveillance Page 3Vulnerability Page 5Transmission Page 8Prevention Page 12Local understandings and treatment-seeking Page 16Burial practices Page 22

In each category, social science lessons learned are highlighted and followed by a series of recommendations. Recommendations are divided into those that are operational, i.e. they are immediately applicable in the event of an outbreak, and those that are orientated towards longer term capacity building. This report will provide the basis for a set of programme-oriented case studies and operational tools that will be published in 2019.

Cholera disease is caused by Vibrio cholerae (strains O1 or O139), with capacity to produce the cholera toxin responsible for acute watery diarrhoea. If untreated, severe dehydration can cause death. The water-borne disease is transmitted through theingestion of contaminated water or food. Cholera is preventable through appropriate water and sanitation infrastructure and vaccines, and treatable through symptomatic therapeutic rehydration and antibiotics. Yet it is estimated that 2.9 million people a year contract the disease, and up to 95,000 die from it. Cholera is a tragic marker of both global and national inequalities in water and sanitation investments, and in access to basic healthcare.

This report focuses on the lessons learned primarily from countries affected by cholera outbreaks in the past four decades, in what is called the 7th Cholera pandemic. The most important case studies considered are the epidemics in Peru (1991), Haiti (2010), South Sudan (2016), India (endemic outbreaks), Mozambique (2014 and 2017) and Zimbabwe (2008 and ongoing outbreak), yet other countries’ experiences are incorporated. Lessons are also integrated from literature around cultural responses to Oral Rehydration Therapy in the context of acute diarrhoeal disease."